Diana Heiman, MD

Associate Professor, Family Medicine

Residency Director

East Tennessee State University

Objectives

Introduce governing bodies in sport

Review banned and restricted

substances

Discuss therapeutic exemptions

List Anti-doping resources

Doping Definition

Use of any substance or method to increase performance, being harmful to the health of the athlete or being against the values of the game

When at least two of the above conditions are present, a substance can be banned by WADA

All athletes are responsible for knowing what is in the foods and supplements they ingest!

Governing Bodies in Sport

World Anti-Doping Agency (WADA)

Established in 1999 to “harmonize anti-

doping policies in all sports and all

countries”

United States Anti-Doping Agency

(USADA)

Created in 2000

The national anti-doping organization for the

Olympic movement in the US

USADA Covered Organizations

Covers all Olympic, Pan American and

Paralympic sport in the US

www.TeamUSA.org

Banned and Restricted

Substances Prohibited at all times

Anabolic Androgenic Steroids (AAS)

Other anabolic agents ○ Clebuterol

○ Selective androgen receptor modulators

Peptide hormones, growth factors and related substances ○ EPO

○ HGH

Beta-2 agonists

Hormone and metabolic modulators ○ Aromatase inhibitors

○ Selective Estrogen Receptor Modulators

Diuretics and other masking agents

Banned and Restricted

Substances

Prohibited methods

Manipulation of blood and blood

components (?PRP OK)

Chemical and physical manipulation

○ Tampering with samples collected during

Doping Control

○ IV infusions of over 50 mL during a 6 hour

period unless related to hospital admission or

clinical investigation

Gene doping

Banned and Restricted

Substances

Prohibited In-Competition

All of the prior substances and methods

Stimulants

○ Bupropion, caffeine, nicotine, phenylephrine, PPA, pipradol and synephrine are not banned (Monitoring Program)

○ Pseudoephedrine banned only when urine concentration > 150 micrograms/mL

Narcotics

Cannabinoids

Glucocorticosteroids (oral, IV, IM, rectal)

Banned and Restricted

Substances

Prohibited in specific sports

Alcohol (In-Competition only)

○ Aeronautic, archery, automobile, karate, motorcycling, powerboating

Beta blockers (In-Competition only unless listed)

○ Archery – also Out-of-Competition, automobile, billiards, darts, golf, shooting – also Out-of-Competition, skiing/snowboarding in ski jumping, freestyle aerials/halfpipe and snowboarding halfpipe/big air

Banned and Restricted

Substances

Monitoring Program

Substances that are not on the prohibited

list, but are monitored for patterns of misuse

in sport

○ Stimulants as previously noted In-Competition

only

○ Narcotics – hydrocodone, morphine/codeine

ratio, tapentadol, tramadol In-Competition only

○ Glucocorticosteroids – Out-of-Competition

only

Testing

Performed In-Competition and Out-of-

Competition

Out-of-Competition testing performed

based upon automated draw taking into

consideration athlete ranking, risk of

doping in the sport, test history

File “whereabouts” forms quarterly so

the athlete can be found for testing

Therapeutic Use Exemption (TUE)

“Permission to use, for therapeutic purposes, substances or methods contained in the List of Prohibited Substances or Methods where Use would otherwise be prohibited.”

Therapeutic - Of or relating to the treatment of a medical condition by remedial agents or methods; or providing or assisting in a cure.

Cases reviewed by TUE Committee made up of at least 3 physicians

TUE

Granted when: Athlete would experience a significant impairment to

health if the substance or method was withheld in treatment of an acute of chronic medical condition.

The Therapeutic use of the substance or method would not enhance performance other than returning the athlete to a normal state of health following treatment of a medical condition. Treatment to increase “low-normal” levels of an endogenous hormone are not acceptable.

There is no reasonable Therapeutic alternative to the use of the substance or method.

The necessity of the use of the substance or method cannot be a consequence of the prior use, without a TUE, of a substance or method which was prohibited at the time of use.

TUE

Cannot be approved retrospectively

except

Emergency treatment or treatment of an

acute medical condition was necessary

Due to exceptional circumstances, there

was insufficient time or opportunity for an

applicant to submit, or a TUE committee to

consider, an application prior to Doping

Control.

NCAA

Drug Testing Policy (WADA-certified labs)

Started in 1986 Started in 1990 90% DI, 65% DII, 21% DIII

NCAA

Banned drugs Stimulants

Anabolic agents

Alcohol and beta blockers (rifle only)

Diuretics and other masking agents

Street drugs

Peptide hormones and analogues

Anti-estrogens

Beta-2 agonists

Restricted drugs and procedures Blood doping

Local anesthetics (under some conditions)

Manipulation of urine samples

Beta-2 agonists allowed with prescription and by inhalation only

Caffeine – if concentrations in urine exceed 15 micrograms/mL

NFL

Policy and Program for Substances of Abuse (part of CBA) AAS

Hormones (and all related substances to agents below) ○ HGH and animal GH’s

○ HCG

○ IGF

○ EPO

Bets-2 Agonists

Anti-Estrogenic Agents

Masking agents ○ Diuretics

○ Epitestosterone

○ Probenecid

○ Finasteride

Certain stimulants (including pseudoephedrine unless prescribed by Club medical personnel)

NBA

Anti-Drug Program (part of CBA) Drugs of Abuse

○ Amphetamine and its analogs

○ LSD

○ Opiates

○ Heroin

○ PCP

○ Marijuana and its by-products

Steroids, Performance Enhancing Drugs, and Masking Agents (SPEDs) – includes stimulants

Diuretics

MLB

Joint Drug Prevention and Treatment Program (part of CBA) Any and all drugs on Schedules I and II of the Code of

Federal Regulations’ Schedule of Controlled Substances (= drugs of abuse), plus below ○ Natural and synthetic cannibinoids

○ Cocaine

○ LSD

○ Opiates

○ MDMA (Ecstacy)

○ GHB

○ PCP

Performance Enhancing Substances – all AAS on Schedule III, hormones and all “designer steroids”

Stimulants (not including PPA or pseudoephedrine)

NHL

Performance Enhancing Substances

Program (part of CBA, may be modified

given current negotiations)

Substances “relevant to the sport of hockey”

modified from the WADA banned substance

list

No list published online…

Antidoping Resources

Partnership for Clean Competition (www.cleancompetition.org)

MISSION: To protect the integrity of sport and public health by engaging and supporting the world's top scientists and innovators in high quality anti-doping research and development.

FOUNDING PARTNERS:

CONTRIBUTORS:

CORPORATE DONORS:Amgen Inc. (2011)

Antidoping Resources

Drug Free Sport (www.drugfreesport.com) The National Center for Drug Free Sport (Drug Free

Sport™) is a company devoted to preventing drug abuse in athletics. As the premier provider of drug-use prevention services for athletic organizations, Drug Free Sport provides strategic alternatives to traditional drug-use prevention programs. More importantly, Drug Free Sport is a SPORT drug-use prevention company. Unlike traditional third-party drug-testing administration companies that conduct primarily workplace and insurance testing, Drug Free Sport works exclusively with sports organizations and their athletes.

Drug testing, drug policy development, education for athletes, resource for athletic trainers and physicians

Antidoping Resources

World Anti-Doping Agency (www.wada-

ama.org)

United States Anti-Doping Agency

(www.usada.org)

Conclusions

WADA and USADA govern all Olympic

and USA sport athletes

NCAA guidelines apply to most

collegiate athletes

All professional sports have their own

testing programs and banned

substances that are linked to the CBA

for that sport